Healthcare Provider Details

I. General information

NPI: 1285835025
Provider Name (Legal Business Name): CHERISE COKLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5145 N CALIFORNIA AVE FL 3
CHICAGO IL
60625-3687
US

IV. Provider business mailing address

1129 BRASSIE AVE
FLOSSMOOR IL
60422-1503
US

V. Phone/Fax

Practice location:
  • Phone: 773-989-3834
  • Fax: 773-275-2433
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036122043
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036122043
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: